What do you think about having to make a second appointment at the doctor?

I perceive it as the doctor wanting more money for another visit. Ditto in the case of going back for lab results. To me, that’s a discussion that can be had over the phone. He can prescribe medication over the phone, too, so why have the patient come in for another visit?

Two reasons.

First, as you suggested above, is scheduling. If the doc takes an additional 20 minutes on the (unanticipated) back problem, then the delay puts the doctor 20 minutes behind on every patient for the rest of the day, and means that the doc probably has to stay later than planned – late for dinner, late for soccer practice, and all that.

But the more accurate reason has to do with billing and reimbursement. In order to get paid by insurance companies,. doctors have to encode each encounter with a patient with a 5 digit number (or sometimes more) that describes the reason for the visit. So if the doctor had previously encoded a 45678 visit and all of a sudden it is a 88443 visit, then it may very well affect the amount and type of reimbursement received.

my guess is that the doctor asked the patient to come in a second time for bookkeeping reasons (primarily) and scheduling as the secondary reason.

For an unplanned treatment (that would take extra time), I wouldn’t mind having to make a second appointment. Often, though, I end up getting a flu shot or something other minor thing during an unrelated visit. Much of the time, it’s my doc’s idea.

For anything else on your list, I would not be happy to have to come back. Glad my doc isn’t like that. Lab results have pretty much always been done by phone, even if a new prescription is required to address bad results. This year, they started posting them online, too, which is nice! He is always willing to listen to concerns other than the main reason you made the appointment.

@elbanditoroso They code the appointment when they bill, so that is done after the appointment.

I realize some of it has to do with the requirements of the insurance company, do doesn’t that mean insurance is raising costs? Even for the insurance company? They insurance company and the patient will have to pay for a second appointment. During the big HMO days I don’t think GP’s got extra money per appointment, they just were paid per patient? I’m not sure though. HMO’s are going away, so that is less of an issue.

One time I went to the dermatologist for an all over check. I had some little dots on my stomach that were dry, I don’t remember what they are called, and I wanted them removed. The doctor said if have to come back for it. That it’s $90 to laser 15 of them, and insurance won’t cover it, because it’s considered cosmetic. I was fine with all of that.

I returned the following week, had the laser done, and paid the money. A few weeks later I get a bill for $9 and change for that second appointment. I called up the doctor’s office, and the billing person said, “that’s your copay for the appointment.”

I said: I paid $90 in full for that appointment, and what copay? It isn’t covered by insurance.

She said: but the doctor looked at you and told you what you needed done, so there is a fee for the office visit.

Me: No. I showed it to her the week before at my appointment and she told me to come back and it’s $90 for the procedure, which I paid. Are you saying it’s more than $90?

Her: don’t worry, I’m going to get rid of the $9 charge for you.

Me: Thanks, but I’m not only worried about the $9 I’m worried you are billing my insurance for something that didn’t happen and that was paid in full be me.

In my opinion that’s insurance fraud, and that shit happens all the time. I was present, in the office, so they billed insurance. They can prove I was there so in an audit it probably would slip right through. It’s still fraud.

@elbanditoroso nailed it. There is no patient ‘care’ in the health care system. Doctors are getting backed into a corner where satisfying the bean counters takes priority over patient convenience, comfort, and timely treatment.

Yes, and the poor doctor will be set back in his schedule.
4 appointments in every 15 minute block of time at, what, $50 per?
She needs to STFU about her back and let the $800 an hour machine hum along.
The BMW dealership doesn’t give a damn about her back.

@ibstubro cynical much?

The doctors are paying their staff, so they don’t pocket all of that $800. The system creates the need for more staff. It’s a monster. There are some doctors who don’t accept insurance. My experience with those doctors is usually very positive.

A specialist for $50 an hour, @JLeslie??
I think not.
I was figuring $120 – 180 for an office call, $50 take-home for the doctor.
We’re not paying for a time-share, but for the summer home on the lake.

@JLeslie: I had one of those doctors who didn’t take insurance. They’re called “Boutique doctors.” He was about $300 a pop, but would sit with you and spend about an hour. Nobody waiting, no phone calls, just one hour on you. His office was in a private house, that he owned, fancy furniture and marble. The whole thing was elegant and luxurious.

He was very popular, too. A good friend worked with someone who was on the verge of surgery for some ailment and she went to him for a second opinion. He researched it and found out what disease she really had, and put her on medication, no surgery necessary. When I went to him, I was on the verge of having my thyroid taken out, due to some misdiagnosis from a pathology lab. Long story short, he sent the biopsy results to his pathologist, no need for surgery and I still have my thyroid today.

I wouldn’t fault the doctor for wanting a separate appt. Something like back pain could take a good amount of time to diagnose, tests ordered like an MRI or CT scan, etc.
Something minor and non-time consuming that could be worked into the existing appt. is fine, but in this case the questioning, exam and tests potentially ordered would take an extra 20–30 minutes which would cause a delay in scheduling. Not any different than going to a hair appt. for a cut and then wanting to add some other service that would be more time consuming and mess up the scheduling.

I totally see it as a scheduling issue. It’s the reason the receptionists ask what you’re coming in for, so they know to whether to schedule a 15 minute slot or a 30 minute slot.

< – Canadian.

Usually, when I schedule a doctor’s appointment, the receptionist will specifically ask whether there are issues I would like to talk to the doctor about – this allows them to schedule enough time, and keep the schedule relatively under control. Despite this, if I have a new problem, or thought of something that didn’t occur to me when I spoke to the receptionist, I bring it up. My doctor never shows any irritation about this, and in fact usually asks me before I leave whether there’s anything else on my mind. I get the feeling that she’s prepared for people to be reluctant to share their health concerns, and to need a little prodding to share information about their bodies.

I try not to save any new problems to bring up at the doctor’s office, out of respect for other patients waiting their turn, not out of respect for the doctor. I am talking here about my GP, but if it were a specialist, my actions would be no different. Seeing a specialist is a rare thing for me, and on those occasions when it has happened, I have used those appointments to gather as much information as possible. I’m not leaving any doctor’s office with questions unanswered.

Edited to add: The only time I have been asked to make a second appointment is if I need test results before continuing the assessment.

@jca I’ve never been to a boutique doctor, but I have thought about it. The doctors I went to who didn’t take insurance were a Gynocologist and a Dermatologist. Also, my current dentist; he’s actually a prosthodontist, but I have had cleanings there too.

@ibstubro LOL. Right, sorry my math was so screwy.

@Coloma I didn’t feel so bad coming back for the cosmetic appointment until they tried to commit insurance fraud. They probably did. I doubt they didn’t still take the money from my insurance.

As far as scheduling, it’s scheduled too tight, and that’s why we have to be inconvenienced and come back again. I don’t mind if my appointment costs me $20 more if I take up more of the doctor’s time. It takes two to three hours of my time to come back a different day. I have to get to the office, wait in the waiting room, and return back home. Some doctors overbook, because some patients don’t show up. Too bad. Someone doesn’t show up make the phone call you need to make. Triage your time. Everyone else does.

@JLeslie If you are finding that this happens to you regularly, perhaps the solution is to tell them that you need a bit of extra time when you book the appointment. If they are unwilling to do that, perhaps it’s time to start seeing a different doctor.

@dappled_leaves Not often. Remember, in my Q my example was my doctor friend bitching about it.

@JLeslie Right, I was responding to your comment that sounded like a generalization immediately above (”... it’s scheduled too tight, and that’s why we have to be inconvenienced and come back again.”). Perhaps I misunderstood what you meant.

My doctor will spend as much time with me as necessary. In return, I often have to wait quite a while for my appointment (she is always running late). She also responds to my emails to her (I don’t know if she offers this for all patients… I doubt it). On the rare occasion that I have seen a partner in her practice when she was unavailable right away, she told me to get a message to her and she would rearrange her schedule to see me herself. I feel completely catered-to by my PCP… and I already feel the pangs of loss when I think about moving away from the area and needing a new doctor.

I have learned to not bring up new issues at physicals for my little ones. There is just not enough time. They are required to ask certain questions and do certain education… and talking about ADHD medication not working (or whatever) needs a separate appointment. I have no issue with that and do not interpret greed on the part of the pediatrician.

I have recently started seeing a functional medicine doctor, which is somewhat similar to the boutique medicine mentioned above, but is a specialty in its own right. I still have my PCP, but see the functional medicine doctor to find the root cause of certain medical issues. I had a one hour appointment with her last week for which I paid almost $400. Follow-ups will be half the time at half the cost. Fortunately, I have carried some money over year-by-year in my HSA account and can afford such care. It is a luxury.

My doctor is like that, @Cupcake. Everybody wants his 1:00 pm slot. If they don’t get it they know they may wait an hour past the scheduled time. But I’ve never heard anyone complain. They know that when their time comes, he’ll give them the same undivided attention.

I have a gyn like @Cupcake‘s doctor. I typically wait 1.5–2 hours in his waiting room, but then I he listens to everything I need to ask him.

@Cupcake Wouldn’t you rather just do both appointments at once and pay what the two appointments cost? It theoretically should be slightly cheaper because it one less set of checking in, checking blood pressure, etc.

@dappled_leaves I would argue most American doctor’s don’t schedule enough time with patients.

@JLeslie I would, of course. But my doctors book far out, so I wouldn’t expect to be able to have back-to-back, or even same-day appointments. If it worked out, great. Amazing, actually. But I wouldn’t expect it.

But, yes. That would be ideal. Even if I had to pay extra. Usually, though, there is something that is more urgent and something else that can wait for awhile.

@JLeslie…. @Cupcake beat me to it. With advance warning the doctors would be happy to book extra time. It’s the last minute, the patient came in just for this, then throws this and this and that and the other thing into the pot that has to be really frustrating to all the staff.

@Dutchess_III I have my doubts that the people who book the schedule actually put in more time if you say you have an issue to discuss while at your check up appointment. Maybe some doctors have great staff members who do it and the doctor is ok with it, but I think that is more likely the exception. Maybe I’m too negative.

Well, that’s just what the receptionist told me when I called in to make an appointment for A, but also wanted to discuss B.

@Dutchess_III Sounds good.

@elbanditoroso is correct: Because the Post-Op visit is a No-Charge visit under contract with the Insurance Corporation, they CAN’T add codes and charges for a separate issue.

@hearkat I see. So, that rule is stupid in my opinion. It’s unfair to the doctor and the patient.

The post-op visit is often BUNDLED in the charges for the procedure. Not to mention it does throw off the schedule, forcing everyone else to wait longer.

@JLeslie The thing you’re missing about the inefficiency is that the insurance company WANTS inefficiencies. They want you to come back for a 2nd visit because it’s an additional co-pay out of your pocket, and it’s one more opportunity for you to forget your referral, or for the provider to mis-code something etc. All of this inefficiency results in them not having to pay out as much because they know x% will screw it up. It’s the same reason companies offer mail-in rebates instead of just discounting the product on the shelf (they know x% won’t do it or will screw it up—not include the receipt, or write the wrong address, etc.).

@gorillapaws I don’t get it. If I go to the doctor my insurance pays part of the visit if I’ve met the deductible. It costs the insurance company money every time I go to the doctor once I meet my deductible.

If I haven’t met the deductible it’s out of my pocket, but that doesn’t make the insurance company any richer.

Am I missing something?

@JLeslie Let’s say you go in for x and need to make a separate appointment for y. A lot of people end up not dealing with y. They can’t afford the co-pays, forget about it, or in some cases die from it (and insurance companies save big bucks in those circumstances since they avoided paying for those treatments). Trust me, if it weren’t in their financial best interest to do it the way they do, they would change it.

Office visits are dirt cheap, hospitalization and surgeries are very expensive, they’re willing to eat the cost of extra office visits if it saves a few surgeries.

@gorillapaws I do avoid addressing medical issues because of my trauma from doctors, and not wanting to pay when I don’t think they will know what’s wrong with me anyway. I don’t mind paying for my medical care if I felt the doctor was competent and not gouging me. Sometimes, it’s not competency, it’s just simply I don’t think a doctor will know. If I can pay $100 for a hair appointment, I certainly can pay that for my health. Although, I’m not also paying for hair insurance.

I have to really think about what you are saying. It makes sense to me that insurance only does what positively affects their bottom line. I’m already disgusted with our system, with insurance, this might make it worse.

I know when HMO’s were created the President at the time and the people creating the system were doing a jig about the money they would make, and sold it to the American people as a better system for them. Part of that structure was putting everything through your primary doctor, which I HATED. I got out of that as soon as I could. Meaning, once it was an option from my employer I switched to a PPO.

Now, I still hear the President, and others, talk about the need for GP’s, and it honestly makes me suspicious. GP’s and internists certainly have their place, and I think they are very important in the medical system, but I think they too often care for ailments that would be better cared for by a specialist, and they don’t refer the patient out. By refer, I don’t mean they have to recommend a specific doctor, I only mean that they suggest seeing a specialist and help the patient figure out what specialty. A lot if us lay people don’t even know all the specialties out there and what helps what. The GP should help navigate that. They rarely do in my experience.

The only time I had great experience with having a primary was when I was in military health care and my main doctors were at Bethesda Naval Medical Center. You had to be careful there to avoid unnecessary surgery, it was a teaching hospital, but otherwise my experience there was very good. I didn’t feel on my own.

I think it might be the cost of health care there? Here the appointments are scheduled according to what is going to be done. If you have something new to talk about when you’re there for something else, you must re-schedule. When I was doing dentistry, we were booked so tightly, that anything more than that made us run way behind. When a patient was there for a procedure and would say ”, oh and I want you to take a look at this, too ”’ I would inwardly scream. Now starts the dominoes falling that make for being behind all day. No lunch, to try to catch up. Getting home home late, a disaster with young children. It seemed to always be the same patients that would do this, so that when you saw their name on your schedule you’d want to cry. There was no easy way to explain that they would need to make a new appointment, so you’d look and hope you could say something they would accept and make another damn appointment.

@JLeslie so what was the diagnosis finally for your pain? Or did I miss it…

Post op visit takes 10 minutes, and is scheduled as such.
A complete new evaluation for back pain would take much longer—unless you want the doctor to do a half-assed job.

Look at it from the point of view of the patient waiting in the waiting room. How would you feel if your appointment was put back an hour, or worse, postponed because a thoughtless individual took up your doctors time with unrelated questions?

It is entirely reasonable and appropriate to need another visit.

^^^^ And that answers the question.

@Rarebear Would my second dermatology appointment in my example be fraud? Charging my insurance for an office visit when I made an appointment for a cosmetic procedure that I paid for in full at the time of the appointment?

I didn’t say anything about fraud, and I don’t know anything about insurance. I’m just talking about being impolite to other patients.

@Rarebear I know, I was just curious about your take on what happened at my dermatologist. If you prefer not to comment on that, no problem. I appreciate the information you provided in your answer.

Could you give us a link to your dermatology issue? It isn’t the one addressed in your details.

@JLeslie I prefer not to comment on it.

@Rarebear No problem. Thanks for responding.

@Dutchess_III I copied it again below:

One time I went to the dermatologist for an all over check. I had some little dots on my stomach that were dry, I don’t remember what they are called, and I wanted them removed. The doctor said if have to come back for it. That it’s $90 to laser 15 of them, and insurance won’t cover it, because it’s considered cosmetic. I was fine with all of that.

I returned the following week, had the laser done, and paid the money. A few weeks later I get a bill for $9 and change for that second appointment. I called up the doctor’s office, and the billing person said, “that’s your copay for the appointment.”

I said: I paid $90 in full for that appointment, and what copay? It isn’t covered by insurance.

She said: but the doctor looked at you and told you what you needed done, so there is a fee for the office visit.

Me: No. I showed it to her the week before at my appointment and she told me to come back and it’s $90 for the procedure, which I paid. Are you saying it’s more than $90?

Her: don’t worry, I’m going to get rid of the $9 charge for you.

Me: Thanks, but I’m not only worried about the $9 I’m worried you are billing my insurance for something that didn’t happen and that was paid in full be me.

In my opinion that’s insurance fraud, and that shit happens all the time. I was present, in the office, so they billed insurance. They can prove I was there so in an audit it probably would slip right through. It’s still fraud.

It was a valid office visit. IMO, a separate office visit charge was warranted. However, in this situation they agreed to take care of your portion of it, but it’s still a valid charge to your insurance company.
Why don’t you call your insurance company and find out? Then you will know whether or not your doctor is a crook.

Why is it valid? My insurance doesn’t cover cosmetic procedures. I paid for it. It’s like having my insurance pay for a facial.

@JLeslie: Doesn’t your insurance company give you notification when they pay a claim or deny a claim?

@jca Yes. This was 5 years ago, and I consciously decided to not call my insurance company and I never checked on it. A year before, I had written my insurance company about another doctor and nothing was done, no response. My husband’s company was self insured, so all of that eventually winds up
on the desk of an employee of his, and my husband at the time didn’t want to hear about the mistakes made and the overcharging, and so I went quiet. It was like he took it personally or something. I’m not sure what was going on there. Now, he has changed a little, he sees the rip-off, or unfairness better now when it’s happening.

I see some sort of fraud, double dipping, or gouge at least once every few years without even trying to dig one up. About 17 years ago I decided to just open my wallet and pay. I was sick, anxious from dealing with the medical system, and decided that getting angry about billing wasn’t worth how it probably shortened my life. At one point I told my husband to deal with the payment, because I will pay everything that is billed even if it’s completely wrong. I’ll pay for tests I never had done (I have been billed for tests that were never done) I’ll pay a doctor bill that came through with a full price when it should be partially insurance, etc. He took care of it for a few years.

Eventually, once I was feeling better, I started dealing with it again. I still kind of just open my wallet. I fight a little about things that are outright wrong in my opinion, but if I don’t get somewhere fast I give up. They win. It’s like my friend says, “it’s the system,” in her Russian accent. She is Russian-American. I get angry and laugh whenever she says it.

@JLeslie: Wow! If you see a claim for a visit that never happened or an overcharge, you just pay it?

@jca I have. I have paid and never go back. I had an office torture me once about an overcharge. I called right away to straighten it out. I was completely calm and nice. I wasn’t angry or hostile. I went back and forth a couple of times with the idiot billing person. I received a certified letter to never go back to the office and was sent to collections. I never said I wouldn’t pay, I was disputing the coding and the amount. Collections started to harass me.

I paid their damn bill and then for the first time in my life I wrote the better business bureau. I sent in a full copy of my credit report showing my perfect payment history and very high score. I gave the dates of when I spoke to the office. It was very detailed. I sent a copy to my insurance and whatever agency for reporting doctors, I don’t remember. I was so fucking mad. I wanted to make them have to take the time to have to respond to the complaints. I never heard a peep from my insurance. I paid them so it became not about the money, but about how I was treated.

Some sort of supervisor responded to the BBB complaint, saying I should have asked to speak to the manager if I wasn’t getting results. My response was I has asked to speak to the doctor twice, they did not call. I didn’t know there is a manager. Maybe the billing person should pass me to her manager if she is unable to resolve an issue rather than think a patient is a deadbeat! I had called, I didn’t ignore the bill and not pay.

By the way, when I logged onto to BBB they had one other complaint and it was for billing.

I regret paying them.

I also regret paying the endocrinologist here in Tampa who charged me over $100 for a 5 minute appointment to be told all my blood tests were normal. He was paid money by my insurance too, I only paid part of the bill. I called the office when I received my bill and the billing person said an appointment like that self pay is $60. Remember, I’m already annoyed I have to go back for I is results to begin with. I was going to fight with the doctor, but I told them to forget it I’ll just pay and never go back. That’s what I did. The billing person should have brought it to the doctor anyway in my opinion.

When I paid $1,000 for my husband’s CT scans and self pay rubs between $550 and $750 depending on the facility. I got them down to $1k it was just over $1,200, and they received money from our insurance also.

It really harms me mentally being aware of these things. Most people are unaware I think.

A good friend had two Caesarians giving birth to her two sons, same hospital. Insurance provider was different for each birth. One birth they charged 20k and the other birth they charged 24k. She called to protest why the price difference and they told her that they charge what the insurance company pays. If the company pays 20k, they charge 20k. If the company pays 24k, t hey charge 24k.

I must admit that I rarely look at what the doctor bills for. My main concern is that my copay covers the part that I’m responsible for and I owe nothing more.

@jca Right, they charge whatever the insurance will pay. Here’s the thing, if you have a high deductible like me, or 70/30 then you notice these differences in charges. Also, the song that the group insurance can fight for lower fees, I don’t see evidence if ten doing it. I catch the opposite all too often. The insurance just charges us more in premiums, it costs them nothing when doctors make more.

By the way, the doctor that I wrote to the BBB, they did refund me part of my money.

Edit: $24k for a c-section. The numbers just boggle the mind. Is that what was actually paid? Or, that’s what the bill said and there was a lower insurance negotiated price?

I imagine it’s maddening to be the billing person at the doctor’s office.

I’m annoyed at my insurance company for a recent denial for eye exam (which I get once a year as part of my policy). I went to a retailer’s independent eye doctor, paid for the exam, and sent the bill to my insurance company. He circled my two diagnoses (myopia and whatever is the code for farsightedness) and he circled one of the types of exams (categories were things like basic, comprehensive, etc.). I think he circled “comprehensive.” They denied it, saying it should go toward my major medical deductible. I argued with them, saying I get one eye exam a year, I hadn’t had one in three years and it’s not like I have any kind of disease. This is just an eye exam for glasses and contacts. I had to resubmit it to get the lousy 27 bucks or whatever part they pay. I’m waiting for the denial or to see if they’ll pay. Very annoying. I could go to a clinic where they take my insurance, and not have to deal with that crap, but I feel like with the eye doctor I go to, I get a better exam.

@jca Oh, I have empathy for most of the billing people. Not that chick who decided I was a deadbeat, but most of them try to help when there is a problem.

I remember when Hillary Clinton took on healthcare during her husband’s presidency and she talked about things like using logic in the system. She spoke of treating people at home rather than the hospital when possible, if the patient preferred it. That it was usually cheaper, but many insurers weren’t covering it. She looked at costs. I wish they would talk to her in depth about her views on healthcare now. I do wonder where she is at on the topic. My feeling is most of America wants to ignore healthcare issues for now in politics.

I think the healthcare system is so broke it’s almost impossible to fix, and no politician wants to deal with that. Obama took a stab at it with The Affordable Health Care Act, which is not perfect but it will be dismantled if Republicans win the presidency.

Now with more Americans getting old, Medicare /Medicaid costs will rise and it will only get worse.

I think as the population ages it is more reason to have a socialized system. Force more money into the system through taxes and get more control on costs. I don’t mean pay higher money in taxes than what we pay in premiums, I mean everyone paying in. There is no guarantee there would be better control in costs. Politicians can be corrupt, we already see them in the pockets of companies and people, in the health care system, but I think we have a better shot with the government than the private sector.

An office visit is an office visit. It’s like a toll booth. Just because you paid the toll last time you went through, doesn’t mean this time is free.

I’ve just never had an experience like yours @JLeslie. Not one that wasn’t immediately resolved when it was brought to people’s attention, anyway.

When I had my first baby I received the billing statement. They were charging for procedures I didn’t have done, such as an episiotomy, stitches, staples, and an epidural. When I called the hospital to ask about it, the gal said, ‘You didn’t have any of those?”
I said, “No.”
She said, “Oh my word! You went completely natural?”
“100%,” I said.
They removed the charges. When I spoke to the insurance company they were glad I had brought it to their attention.

What free? I paid for the appointment. I paid $90. If a dermatologist lasers or botox’s your wrinkles away can they bill your insurance for it? No! That’s basically what I had done, a purely cosmetic procedure.

You paid for the procedure, but not the office visit. It’s good that they credited it because I also think it was redundant, but I don’t think the charge itself was illegal. We need to get someone familiar with billing in on this.